Diffuse large B-cell lymphoma with involvement of the kidney: outcome and risk of central nervous system relapse

Abstract

BackgroundRenal involvement is uncommon in diffuse large B-cell lymphoma. Recent data suggest that it is an independent risk factor for central nervous system relapse. We reviewed the clinical features, risk of central nervous system involvement, and survival of patients with diffuse large Bcell lymphoma with involvement of the kidney at diagnosis. Design and MethodsAll patients with diffuse large B-cell lymphoma and renal involvement diagnosed from January 1, 1982 to December 31, 2008 at the British Columbia Cancer Agency were retrospectively identified in the Lymphoid Cancer Database. Patients were included if they were 16 years old or over, had advanced stage disease [stage III /IV, or stage I/II with B symptoms or bulky mass (>10 cm)] and were treated with curative intent. Central nervous system involvement was diagnosed by cerebrospinal fluid cytology, radiology or clinically. ResultsWe identified 55/2656 (2%) patients with diffuse large B-cell lymphoma and renal involvement at diagnosis. The male to female ratio was 2:1. The patients' median age was 58 years. Bilateral renal involvement was present in 24 (44%) and stage IV disease in 50 (91%). The International Prognostic Index score was 3, 4 or 5 in 52 (95%), the glomerular filtration rate was less than 30 mL/min/m 2 in 9 (16%) and elevated lactate dehydrogenase was recorded in 46 (84%). Twentyfive (46%) patients received CHOP plus rituximab and 30 (54%) received CHOP-like regimens without rituximab. In total, 20 (36%) patients had central nervous system involvement: four at the time of diagnosis and 16 at relapse. The median time to central nervous system relapse was 5.6 months (range, 1.2 months-4.6 years), and was not affected by the addition of rituximab (P=0.547). The 5-year overall and progression-free survival rates for the whole cohort were 29% and 25%, respectively. In patients who received rituximab, there were trends towards improved 5-year overall survival (43% versus 18%, P=0.071) and progression-free survival (40% versus 13%, P=0.057). ConclusionsThere is an exceptionally high incidence of central nervous system relapse in patients with diffuse large B-cell lymphoma and kidney involvement at diagnosis. The addition of rituximab may improve overall survival in this poor-risk population, likely through improved control of systemic disease.

Extensive Extranodal Involvement of Rare Sites in Non Hodgkin’s Lymphoma Detected on 18F- FDG PET-CT: A Case Report

“…In most of the cases it is secondary and occurs by hematogenous spread or by direct extension of the disease from a retroperitoneal mass. Villa et al concluded that there is a high incidence of central nervous system relapse in patients with DLBCL and kidney involvement at diagnosis [18][19][20]. Fig.…”

Central nervous system relapse in peripheral T-cell lymphomas: a Swedish Lymphoma Registry study

“…1 It is an uncommon event, with incidence numbers ranging from 2% to 7% in large cohorts dominated by aggressive B-cell lymphomas. [2][3][4][5][6][7][8][9] Risk factors for CNS relapse have not been entirely consistent between studies but have included specific anatomical sites, high proliferation rate, and advanced disease. [2][3][4]8,10 The addition of intrathecal treatment to chemotherapy has commonly been used to avoid CNS relapse in patients deemed at high risk.…”

Guidelines for diagnosis, prevention and management of central nervous system involvement in diffuse large B-cell lymphoma patients by the Spanish Lymphoma Group (GELTAMO)

“…5,[19][20][21] A growing body of evidence indicates a higher CNS relapse rate among patients with renal involvement by lymphoma. Villa and colleagues 22 reported CNS involvement in 36% of patients with DLBCL with renal involvement. Similarly, Tai and colleagues 23 found that renal involvement was the primary risk factor for CNS relapse, ahead of even breast or testis involvement.…”